Comparison of Anterior Cervical Discectomy and Fusion with Cervical Laminectomy and Fusion in the Treatment of 4‐Level Cervical Spondylotic Myelopathy

Abstract

Objective: To assess and compare the therapeutic effects of Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Laminectomy and Fusion (CLF) in the treatment of 4-level cervical. Methods:We performed a retrospective review on 39 patients with 4-level CSM who underwent ACDF or CLF in the Third Hospital of Hebei Medical University from January 2010 to December 2018. The patients were divided into ACDF group and CLF group according to the treatment. The operative index was evaluated based on intraoperative blood loss and operation time. The functional outcomes including Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) of axial pain were compared. The Cobb angle, Cobb angle improvement rate, range of motion (ROM) and ROM loss ratio were measured for radiographic evaluation. Results:No major complications or deaths occurred. The average age at baseline was 55 years. There was no significant difference between the ACDF and CLF group in follow-up time (26.29 months, 25.39 months, P > 0.05). The intraoperative blood loss was higher in the CLF group than in the ACDF group (692.67 AE 38.68 vs 392.14 AE 128.06, P < 0.05). The operation time was longer in the CLF group than in the ACDF group (206.60 AE 49.37 vs 172.64 AE 31.96, P < 0.05). Significant improvements in the VAS and JOA scores were observed in both groups (P < 0.05). No significant difference in VAS was found between the ACDF and CLF groups (P < 0.05). There was a significantly larger improvement rate of JOA score in the ACDF group than in the CLF group (60.9% AE 9.57% vs 31.5% AE 15.70%, P < 0.05). There were two (9.6%) cases with complications In the ACDF group, including one (4.8%) case of dysphagia and one (4.8%) case of pharyngodynia. In the CLF group, two patients (11.1%) developed C 5 palsy. No significant difference in the incidence of complications, ROM loss ratio and Cobb angle improvement rate was found between group ACDF and group CLF (all P < 0.05). Conclusion:Both ACDF and CLF were effective in the treatment of multi-level cervical spondylosis and ACDF is more suitable for patients with 4-level CSM.

Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation

“…The risk of postoperative dysphagia, cage subsidence, and nonunion may be higher with multi-stage ACDF [ 4 , 5 , 7 ]. In our study, no cage subsidence was found in the anterior group, and according to Bridwell fusion grade [ 20 ], anterior fusion reached grade I in 28 cases (71.8%) and grade II in 10 cases (25.6%) in the anterior group, and posterior fusion reached grade I in 25 cases (75.8%) and grade II in 8 cases (24.2%) in the posterior group.…”

“…Surgical decompression can enhance neurological function and prevent future deterioration [ 1 , 2 , 3 ]. Although surgical treatments have greatly enhanced over the last few decades, there is still no consensus approach for treating multilevel DCM (MDCM), particularly 4-level DCM [ 3 , 4 , 5 , 6 ].…”

“…Treatment of MDCM with ACDF using a conventional plate-cage structure is associated with improved neurological function and better kyphosis correction. However, a higher number of surgical levels, high-profile internal fixation, and prolonged muscle traction may lead to a higher rate of cage subsidence and nonunion, as well as a higher incidence of dysphagia [ 4 , 5 , 7 ]. Zero-profile cages have been trialed in MDCM, which help reduce the risk of developing dysphagia, but higher-risk cage subsidence rates and cervical alignment problems must be considered [ 8 , 9 , 10 ].…”

Risk Factors for Significant Intraoperative Blood Loss during Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases

“…These treatments often provide a positive outcome for the patient and are associated with a low rate of complications. [9][10][11][12][13][14] The overall rate of any complication experienced a significant decline from 2006 to 2016 after the introduction of ACF (24.5 to 20.8 per 1000 inpatient days). 9 Some studies have shown that anterior cervical discectomy and fusion (ACDF) was associated with lower intraoperative blood loss and better cervical lordosis preservation.…”

“…9 Some studies have shown that anterior cervical discectomy and fusion (ACDF) was associated with lower intraoperative blood loss and better cervical lordosis preservation. 10,11 Anterior cervical corpectomy with fusion (ACCF) is the preferred surgical procedure due to its higher improvement in Japanese Orthopaedic Association (JOA) score following treatment for the ossification of posterior longitudinal ligament (OPLL). 14 Significant intraoperative blood loss (SIBL), which was defined as intraoperative blood loss of 500 mL or more, may result in hypotension, hypoxia of tissues and organs, and nerve ischemic injury, thus increasing the recovery time and the morbidity and complication rates.…”